Over the last six months these teams have come up with new ways of supporting families during a pandemic. These case studies highlight the vital role that health visiting and school nurse services play in identifying problems early and giving children the best start in life.
Our case studies
Councils and their public health teams are responsible for commissioning the Healthy Child Programme 0-19, led by health visitors and school nurses.
Over the last six months these teams have come up with new ways of supporting families during a pandemic.
These case studies highlight the vital role that health visiting and school nurse services play in identifying problems early and giving children the best start in life. With thanks to all our participants, the Institute of Health Visiting and the School and Public Health Nurses Association.
Knowing me, Knowing you Groups, Hampshire
Jo, New Parent: So when you've just had a baby and you're kind of in the beginnings of it, it can be completely overwhelming.
Cas, New Parent: So yeah, without the help of the health visitors I would be in a very dark place.
Text:1 in 5 women will experience mental health issues within the first year of birth.
122,000 babies under one are living with a parent who has a mental illness.
Maternal suicide is the leading cause of death in women during the perinatal period.
Dawn Brenchley, Specialist Health Visitor for Perinatal and Infant Mental Health: Here in Hampshire, before lockdown, we had provided face-to-face groups for women who were feeling low in mood or anxious and those groups were called “Knowing me, knowing you” groups.
This allowed mums who were feeling low in mood or anxious to come together and share their experiences and receive the support that they needed.
Cas, New Parent: It was truly invaluable to not only listen to the content that the health visitors were delivering to help us with coping mechanisms and to understand why this was happening to us and make us feel like we were more confident mothers and that we can do this.
Dawn Brenchley, Specialist Health Visitor for Perinatal and Infant Mental Health: Specialist health visitors in perinatal and infant mental health are experts in understanding babies’ infant mental health and their development.
If health visitors are able to support families quickly enough it can have a huge impact on the mental and physical development of a child.
Cas, New Parent: When lockdown was announced I was in denial for the first couple of weeks and then I went into complete shutdown. The realisation that I no longer had that support network was horrendous.
Dawn Brenchley, Specialist Health Visitor for Perinatal and Infant Mental Health: We knew that if people were feeling isolated and anxious during this time, there were risks to the mums and the babies. We knew we needed to move quickly and so by April we were able to set up groups in a virtual way.
Jo, New Parent: When, sort of, the veteran group was confirmed, it was a real relief because you kind of thought well, I’m actually going to be able to do this.
Dawn Brenchley, Specialist Health Visitor for Perinatal and Infant Mental Health: We were concerned that mums and babies might feel tired in a virtual setting and that meant that we had to revise the materials that we used to make sure that they were appropriate.
Jo, New Parent: The delivery just seemed very professional and very, you know, the same as it would be if you were doing it sort of face to face.
Dawn Brenchley, Specialist Health Visitor for Perinatal and Infant Mental Health: Overall in Hampshire during lockdown we supported over 45 families and the feedback that we've had and the outcomes that we've been able to measure have been really positive in that time.
I'm really proud of the work that all of our health visiting teams have done during this time to continue to provide support to families who really needed it in a very difficult time.
Jo, New Parent: I can't thank them enough for what they've done for me and I know everyone's experience is different but they went out of their way to do everything and provide all the support that they could.
Walk and Talk, Northamptonshire
Eva Trkulja, Specialist Community Public Health Nurse, School Nurse: School nurses play a vital role in the health and wellbeing of children aged 5-19, all within a school setting, within the community and within the family.
We look after their physical, emotional, mental and social wellbeing.
Quotations from Parents
Parent 1: Before the face-to-face solution my daughter wasn’t in a good place at all.
Parent 2: I dread to think where the family would be now without the support we’ve had.
Parent 3: The walk and talk sessions had a huge impact on my child.
Debbie Craggs, Specialist Community Public Health Nurse, School Nurse: When Covid hit we had to suddenly step away from doing our face-to-face contacts. We already had our Chathealth service, as well as using the phone and some video calling but we were missing that physical connection.
Eva Trkulja, School Nurse: If students are struggling with emotional distress and they don’t get the support they need at an early time, that can often lead to more serious or worrying mental health concerns.
So we needed to come up with a solution that meant we could meet with students face to face.
Debbie Craggs, School Nurse: As a team, we were then looking at different solutions and the suggestion was made about walk and talk and using space out in the community to actually see these young people that were struggling to engage in any other format.
Eva Trkulja, School Nurse: We found local parks offered a real sense of tranquillity, which really helped.
Debbie Craggs, School Nurse: That face to face contact through the walk and talk meant that actually we could give a deeper assessment as to how their mood was, how they were coping physically and address those issues in a more personal way.
So a small team sat down to write a protocol that looked at keeping staff and young people safe.
The school nursing service is really important because it allows us to build those connections with young people and allows them to discover strategies and build their own resilience so that they can take that forward into adulthood.
Eva Trkulja, School Nurse: We know that healthy children will grow to be healthy adults.
There was a recent report this year from the Royal College of Paediatrics and Child Health, which highlighted that actually, the health of children is stalling. So, if we can invest now in services like school nursing, then that will have a really positive impact for the future of the health of our nation.
The ICON Programme, Stockport Family
Text: In March 2020, covid-19 changed the way Health Visiting Teams supported parents with new babies.
Early Years Workers: Mostly, our home visits stopped overnight
Early Years Workers: There were a lot of parents who were anxious
Maura Appleby, Principle Lead, Health, Stockport Family: Health visitors are commissioned by local authorities, our local councils, to provide a public health nursing service which enables families and children to have the best start in life.
Due to the pandemic, we had to reduce the number of face-to-face contacts with parents, and this was a concern.
Text: Without support, babies can be at risk. Parents can also suffer from mental illness.
Alexandra Jeffries, Early Years Worker, Stockport Family: Two of the main things that parents can really struggle with is infant feeding, for one, and crying and learning how to cope with a crying baby and the best way to manage that.
Laura Widdall, Infant feeding co-ordinator, Stockport Family: We had lots of parent with brand new babies, who were coming home. They may have had less support than they anticipated having from their friends and family. And so we needed to make sure that as a health visiting service, we were meeting some of those needs.
We had 12 early years workers who very quickly came forward with real enthusiasm and flexibility and were able to retrain them to work in a completely different environment.
Text: These early years workers supported the work of health visitors and were deployed to meet with new parents on maternity wards before they went home.
Key advice was offered on infant feeding and a new programme that deals with crying was adopted.
Laura Widdall, Infant feeding co-ordinator: We decided to look at the ICON programme, and that’s a really good programme that talks to parents about the fact that it’s normal for babies to cry as part of their way of communicating with us and also an opportunity to talk about ways to settle and soothe their babies and to tune into their babies and equally what to do when they feel that crying hasn’t stopped and they’re beginning to feel overwhelmed.
Text: The ICON Programme
I – Infant crying is normal and it will stop
C – Comfort methods can sometimes soothe the baby and they crying will stop
O – It’s OK to walk away if you have checked the baby is sage and they crying is getting to you
N – Never ever shake or hurt a baby
Alexandra Jeffries, Early Years Worker: A crying baby, especially if that baby’s been crying for a long period of time, it can bring up feeling of kind of stress, frustration, even anger.
Rochelle Morris, Early Years Worker, Stockport Family: We approach it by just having it as a gentle conversation with the families. It’s an amazing project and I think everyone should be running the ICON project. It’s amazing.
Valentina Ceccacci, New Parent: Having someone, you know running us through why the babies cry, how to cope with it, and not just the first few days. There’s kind of a breakdown in the leaflet they give you, that goes through the six, seven months and all the growth spurt that they have that can cause huge cries, and that was really, really useful.
Text: In 3 months, the team managed 917 face-to-face discussions with new parents.
Their work helped protect the NHS by offering early intervention, preventing more serious issues.
Valentina Ceccacci, New Parent: During a pandemic, really they were my only point of touch, and face-to-face as well with the feeding team so I just couldn’t have done without them I think.
Alexandra Jeffries, Early Years Worker: Everybody has pulled together. We’ve been able to be flexible.
Rochelle Morris, Early Years Worker: We were very much, “What can we do for our families?”
Laura Widdall, Infant feeding coordinator: It would be really wonderful to see more nurses joining organisations such as Stockport Family who are providing that support to families with young children, to increase the range of support that we could offer. When we recognise that supporting families means better outcomes for children.
Covid -19 Support for Schools, Newham
Ruth Cohen, Quality Assurance Advisor: Our team is made up of some specialist public health nurses qualified in school nursing, some community nurses, nursery nurses and school nursing assistances and we are here to support the children and the families of school aged children here in Newham.
We work with GPs, with school themselves, with maternity services, obviously with children’s social care, and we work and support leading the Healthy Child Programme. And that’s looking at the emotional and physical health of children, again school aged in the borough.
Prior to lock down, about 180 children in Newham were taken to the local hospital every day to the A&E department. And at the very worst time during April, those numbers dropped right down to about 30.
So, we knew that the fear of catching covid-19 and the stay at home messaging was preventing families from accessing emergency care, and obviously that could potentially be life threatening. That meant, of course, that we had a responsibility as public health nurses to try and encourage families and to make sure that they knew that hospitals were open and ready to receive children in an emergency or an accident.
Heather Robinson, Transformation Lead: So we decided that the best approach to spread the message that A&E was safe to visit, was to quickly produce a video with clear information that followed the NHS guidance.
So we put this video out on our council website. We shared it with our partners such as GPs and head teachers, and in June, we put it on Youtube.
Children: Go to A&E
Heather Robinson, Transformation Lead: Currently A&E attendance figures for children have risen from 30 to 125 a day.
Kerry-Ann San Miguel, Newham parent: It was very useful seeing that A&E video and it was good timing because my son, who’s asthmatic, had to go into A&E. So it just gave us the reassurance and the confidence that we could go into A&E without any problems.
Thelma Mukashra, School Nurse Public Health Advisor, Covid-19 lead: So we increased our support for schools and parents by bringing in a public health nurse, and she was providing advice and support related to covid-19 issues.
We also have a telephone response service whereby schools and parents can call in if they needed advice and support again.
We were also able to assist head teachers and GP’s. With head teachers, where they were being inundated with a high volume of calls, we were able to relieve that pressure from them, especially to allow them to focus more on education, rather than the infection control side of things when the children were returning back to school.
Fiona Hall, Headteacher, St James Church of England Junior School: It was initially difficult to navigate covid related issues. Some parents had been misinformed about when they should keep a child at home. The telephone response service made a difference and allowed us to signpost parents and families to the number.
Rebecca Heald, School Health Specialist Clinical Lead: So we had regular touch-in meetings with the head teachers, and this was just to provide them with support and advice and answer any questions that they had around covid.
We were able to continue supporting their pupils that were vulnerable and had long term conditions. We were also reviewing their care plan, so this was done virtually as well. So for asthma, where we know this is a high risk area, we could review their care plan that was in school and make sure that they were safe on their return.
Child: Let’s go back to school.
Rebecca Heald, School Health Specialist Clinical Lead: We also produced a return to school video and this was to help parents, children and young people return back to school. So where people were worried they could see what had been implemented in school, so they felt that the school environment was safe.
Child: Let’s go back to school. The wheels are turning. Back to seeing our friends, back to learning. Stay safe at school.
Muhammad Imran, Newham parent: I saw the video on YouTube. I showed to the kids and the way it was made, it was fun to watch them. So it really helped.
Child: So finally we have arrived. Stay safe at school steps 1 to 5.
Ruth Cohen, Quality Assurance Advisor: I’m really proud of the way that our teams and our service has been able to flex and adapt the way that they work so that they can support schools, children and families, in really difficult personal circumstances.